The bronchodilating consequence of terbutaline dry powder inhaled via Turbuhaler was compared with terbutaline inhaled via a conventional.

The bronchodilating consequence of terbutaline dry powder inhaled via Turbuhaler was compared with terbutaline inhaled via a conventional, chlorofluorocarbon (CFC) inhaler and Nebuhaler (750 ml spacer) in 68 consecutive patients attending the necessity department with acute severe bronchial obstruction. The inquiry was of an open, randomized, parallel cluster design with one study day. Patients were treated with 25 mg of terbutaline 15 min apart, either as dried powder via Turbuhaler or with a CFC inhaler in conjunction with Nebuhaler. Data from 62 patients were analyzed. The mean baseline [FEVsub1] values were 081 L (SD 064; range, 014 to 274 L) in the Turbuhaler arrange (n = 33), and 090 L (SD 090; range, 027 to 260 L) in the Nebuhaler cluster (n = 29). The mean increases in [FEVsub1] from baseline were 040 L (SD 040; range, 006 to 236 L) and 021 L (SD 025; range, - 005 to 095 L) 10 min after the last inhalation via Turbuhaler and Nebuhaler, respectively. The difference between mean values of the increase in [FEVsub1] after terbutaline treatment with Turbuhaler and the CFC inhaler and Nebuhaler was statistically significant (p = 00004 ANOVA). This close attention showed that inhalation of terbutaline via Turbuhaler produc a significantly greater increase in [FEVsub1] compared with the same dose of terbutaline administered via the CFC inhaler and Nebuhaler in patients attending the exigency department with acute severe bronchial obstruction.

The [[beta].sub.2]-agonists at handed in chlorofluorocarbon (CFC) inhalers have prolonged been first-choice treatment of obstructive lung diseases. latter studies have questioned the part of CFC inhalers containing preservatives and lubricants because these additives strike one as being to produce acute bronchoconstriction in highly reactive subjects[12] Multidose dried powder inhalers without additives are now being used increasingly, nevertheless their use in treatment of patients with acute obstructive lung diseases remains to be established. The general major bear upon is that patients might not be able to furnish a sufficient inspiratory flow to benefit.

Bricanyl Turbuhaler is an inspiratory flow-driven craving drink powder inhaler that is preloaded with 200 doses of terbutaline sulfate delivering 05 mg by dose.[3] The effect is maximal for each dose at a peak inspiratory deliquesce (PIF) through Turbuhaler of 30 L/min or more, further even a mean peak inspiratory come of 13 L/min is sufficient to yield a clinical effect[4]. In acute stern asthma, it has been shown that a decrease in mean inspiratory liquefy does not occur until forced expiratory whirl in one second ([FEV.sub.1]) is les than 25 percent of predicted normal value.[5] latter data showed that only 2 of 99 patients attending an crisis department with severe bronchial obstruction had a PIF by the agency of Turbuhaler of less than 30 L/min and none of them had a PIF below 25 L/min.[6] After exercise-induced asthma, inhalation via Bricanyl Turbuhaler has been shown to give a useful bronchodilating effect.[7,8] Thus, Turbuhaler would be an alternative to Nebuhaler (750-ml spacer) for administering terbutaline to patients with acute exact bronchoconstriction. However, this hypothesis has to be prov In the at hand study, the bronchodilating effect of terbutaline sulfate gunpowder inhaled via Turbuhaler or via the CFC inhaler and Nebuhaler was compared in patients with acute simple bronchial obstruction.

METHODS

Patients

All patients attending the necessity department with acute severe obstructive lung disease and an age of more than 18 years were included during a 5-month period. The contemplation was of an open, randomized, parallel form into groups design.

Patients in ne of acute respiratory intensive care were to be exclud as were patients with significant cardiac disease or known hypersensitivity to sympathomimetics.

The meditation was approved by the local Ethics Committee in Copenhagen and the National Board of Health and was performed in accordance with the Declaration of Helsinki.

All measurements were performed from the principal investigator. On admission, basal [FEVsub1] peak expiratory arise (PEF), respiratory rate, heart rate, and line pressure were measured and arterial kin gas analyses were performed. Patients were asked about all mix with drugs intake during the last 24 h before arrival at the hospital. Immediately thereafter, patients were randomized to treatment with either terbutaline, 05 mg five hard inhalations via Turbuhaler, or terbutaline, 025 mg ten shrewd inhalations via the conventional CFC inhaler and Nebuhaler. Inhalations were taken in accordance with the user's instruction for each device and treatments were carefully monitored by the agency of the principal investigator. Ten minutes later, [FEVsub1] and PEF were measured as well as fruit of leguminous plants rate, blood pressure, and respiratory rate. Fifteen minutes from close attention start, another and equal dose of terbutaline was administered by the agency of the same route as the first and 10 min later the same measurements were performed. No administration of other asthma treatment was allowed during the contemplation which lasted for approximately 1 h by patient. Patients were exclud from data analysis if [FEVsub1] increased les than 10 percent in succession the day of hospital admission and les than 15 percent at a later visit within 2 months.

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